Cerebral protection, brain repair, plasticity and cell therapy in ischemic stroke.

Among available treatments in the acute ischemic stroke, only intravenous thrombolysis has been demonstrated to be efficacious. Although the majority of pharmacological neuroprotectants have been efficacious in experimental studies, they have failed in clinical trials. Hence, we need to consider integrated cerebral protection which includes the concept of cerebral repair by supporting cerebral plasticity. We provide a nonsystematic review of the studies published on cerebral protection and repair treatments of cerebral ischemia considering the possibilities of stimulating brain plasticity by trophic factors and cell therapy. The majority of the neuroprotective drugs have failed in clinical trials. Citicoline shows a benefit in meta-analysis and it is currently being explored in a new trial (ICTUS). Neuroprotective drugs combined with reperfusion offer favorable results in experimental animals, but data from clinical studies are not enough. Repair therapies using cerebral plasticity stimulation (trophic factors) and cell therapy have shown certain efficacy in experimental and clinical studies and they are a developing route with clinical therapeutic perspectives.